Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Mountain View Hospital is looking for a Case Manager/Utilization Review to join our team!
JOB SUMMARY:
Performs utilization review activities in accordance with all state and federal mandated regulations in order to evaluate the necessity, appropriateness and efficiency of medical services provided. Maintains compliancy with regulation changes affecting utilization review and case management. Reviews patient’s records assists in evaluating patient’s progress and performs continuing review for identification and need of on-going hospitalization. Obtains and reviews necessary medical records and subsequent treatment plans to conduct reviews. Reviews and validates physician orders are carried out, reports progress and unusual occurrences on patients to department supervisor. Ensures cost effective and appropriate health care services are provided to all patients regardless of patients funding. Assists in maintaining review and appeal logs, participates in interdisciplinary collaboration with professional staff. Assists collaborating with other departments in discharge planning. Supports clinical improvement activities of Mountain View Hospital and Idaho Falls Community Hospital by providing quality review. Performs administrative duties; receives and generates a variety of reports as needed. Assists in assessing the physical, functional, social, psychological, environmental and financial needs of patients. Assists with referrals to appropriate community resources and contributes to the assessment of patient’s support systems. Acts as a patient advocate by assisting in acquiring appropriate medical, nursing or other health care in the home or clinic setting as needed upon discharge. Maintains accurate patient records, ensuring patient confidentiality. Contributes and assists in the performance of case management activities, and contributes to the assessing, planning, implementing, coordinating, monitoring and evaluating of the needs of patients for services both during and after hospitalization. Assists the department head in the supervision of the utilization of resources to promote quality, cost-effective outcomes for the patient and the patient’s family.
BENEFITS:
Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:
Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.
DUTIES AND RESPONSIBILITIES:
About Mountain View:
Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.
Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.
Education/Certification: Graduate from an accredited school of nursing with current license as an LPN or Registered Nurse in the state of Idaho, with specialized training and/or experience in Utilization Review. Strong knowledge of modern nursing principles, techniques, and procedures for the care of patients, with emphasis on growth and developmental needs of patients from birth to death. These skills may be obtained through formal educational programs, training or experience. A strong knowledge base is needed in medical terminology, anatomy and physiology, and concepts of disease.
Experience: Minimum Three years nursing.
Equipment/Technology: Computer and Internet experience
Language/Communication: Excellent written and verbal skills
Mathematical Skills: Excellent
Mental Capabilities: Must have excellent critical thinking skills.
Interpersonal: Shall at all times demonstrate professional behavior.
Performance: Must work well under pressure and meet multiple deadlines, and be able to multi-task.
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